1. Relevant and Pertinent Short Survey Results
Summary
May 5, 2016
Robert Dieterle
Holly Miller, MD
Russel Leftwich, MD

2. Summary of Participation
Organization
Total
ToC1
American Academy of Family Physicians
103 62
American Hospital Association 34 28
American Medical Association
433
163
Other 43 23
613
275
Note 1: ToC – declared they have received ToC Documents
Note: there are no significant differences in in answers between the full set of respondents and the 275 that have experience receiving ToC documents

3. Demographics
Practice location distribution matches US population distribution
General Practice and all relevant specialties represented
All practice types (IDN/Hospital/Unaffiliated) represented
Response by practice size represents solo to >20 provider practices
All payer types well represented

4. EHR and ToC Experience 84% have used EHRs for more than 3 years
64% have or plan to send ToC documents
47% have received ToC documents
hospital discharge and consults are the most common documents (80% receive at least one of each per month)
44% review the ToC as a document
33% incorporate discrete clinical data personally
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5. General ToC Issues 56% declare too much information
46% declare needed information is missing
73% declare ToC organization and 57% declare lack of a clear summary are a problem
>31% did not receive ToC in a timely fashion

6. Hospital Discharge
81% want same information as traditional discharge summary
68% want limited information rather than all hospitalization data
43% declare that important information is missing over 50% of the time

7. Ambulatory
>81% want all information from the current ambulatory visit
>87% want new or changed information from all ambulatory visits
49% declare they receive all information from the current ambulatory visit in the ToC at least 50% of the time
29% declare that important information is missing over 50% of the time

8. Value of Specific Information
Hospital Discharge and CCD
18 of the 26 sections (includes optional sections) are considered valuable or necessary by over 50 % of those receiving ToCs
Of the 26 sections listed only 4 are consider valuable or necessary by less than 30% of the respondents
Ambulatory (consult/progress note/CCD)
20 of the 28 sections (includes optional sections) are considered valuable or necessary by over 50 % of those receiving ToCs
Of the 28 sections listed only 1 is consider valuable or necessary by less than 30% of the respondents

9. Scope Preferred for Specific Information
Hospital Discharge and CCD
65% want all procedures (from all hospitalizations)
Roughly 50% want last available functional status (51%), plan of treatment (51%), review of systems (66%) and vital signs (48%)
Hospital studies and results are equally distributed between last, first and last and all
Ambulatory (consult/progress note/CCD)
Majority want functional status (77%), plan of treatment (74%), problems (64%), procedures (52%) , results (65%) review of systems (87%) and vital signs (79%) from the current visit only (not from prior or all visits)

10. Medications Hospitalization Ambulatory Visit
89% declare active and prescribed meds at discharge necessary (60% declare they are always received)
admission (88%) and administered (82%) medications necessary or useful (<25% declare they are always received)
Ambulatory Visit
new (89%) and discontinued (83%) medications are necessary (52% declare they always receive new meds and only 31% declare they receive discontinued meds)
68%% declare current meds at time of visit are necessary (43% declare they are always received)

11. Alternative Approaches
39% want to receive less information
61% want to receive more information if they have better display and incorporation capability
A significant number of respondents want (4 or 5 out of 5)
User defined summaries (48%)
Table of contents with links (44%)
Drag and drop for incorporation of discrete data (47%)
Automated incorporation (44%)
Detection of duplicate data (53%)

12. Comments and Follow-up
Count
Percentage
Contact information
142
23 %
Willing to participate
278
46 %
Providing contact information
129
Provided exit comments 86
14 %
Note: this from all respondents

13. Summary 47% of responding providers currently receive ToC documents
Hospital visit – want same information as paper discharge document
Ambulatory – want all information from current visit
Ambulatory – want changed information from prior visits
Over 50% want 18 of 26 and 20 of 28 sections
Only 4 sections of discharge summary / CCD and 1 section of consult/progress note/CCD are wanted by <30%
56% want less information -- appears to be related to repeated sections (e.g. results / vitals from hospitalizations) and prior visits
61% want better tools to review and incorporate
46% declare important information is missing in ToCs